Wetland MRT forms 20231690_Western Sewer System

DocuSign Envelope ID: EECA1 FE7-7C66-4B52-9310-77FBB4A23260
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
COMPENSATORY MITIGATION RESPONSIBILITY TRANSFER FORM
April 11, 2024
Permittee: Brooks Lockhart & The City of Roxboro DWR Project #20231690
Project Name: Western Sewer System - Gravity Sewer, Force County: Person
Main & Southside Pump Station
The Division has received an acceptance letter from the NC Division of Mitigation Services (DMS) to
satisfy the mitigation requirements set forth in 401 Individual Certification No. WQC006654 issued to
Brooks Lockhart & The City of Roxboro, dated February 15, 2024, as provided in the table below.
Compensatory Mitigation
River and 8-digit HUC Number
Riparian Wetland
0.244 acres (credits)
Roanoke River Basin
03010104
The Permittee must provide a copy of this form to DMS who will then sign the form to verify receipt of
payment and the transfer of the mitigation responsibility. Once DMS has signed this form, it is the
Permittee's responsibility to ensure that a signed copy of this form is submitted to the Division before
conducting any of the authorized impacts.
The Division of Mitigation Services verifies that the mitigation requirements (credits) shown above will
be debited using approved released or advance credits, and for all stream or wetland credits is in
accordance with the signed/approved In -Lieu Fee Instrument dated July 28, 2010. By signing below,
DMS is accepting full responsibility for the identified mitigation. As a reminder to the Mitigation
Provider, no more than 25 percent of the total mitigation required by Division can be met through
preservation, unless requested and approved by the Division Director (15A NCAC 02H. 0506(c)(7)).
Signature Authority Name (print):
Signature:
Date:
p North Carolina Department of Environmental Quality I Division of Water Resources
D�J) Raleigh Regional Office I 3800 Barrett Drive I Raleigh, North Carolina 27609
NOR1H CARouNa �/ 919.791.4200

DocuSign Envelope ID: EECA1 FE7-7C66-4B52-9310-77FBB4A23260
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
April 11, 2024
Permittee: Brooks Lockhart & The City of Roxboro
Project Name: Western Sewer System - Gravity Sewer, Force
Main & Southside Pump Station
DWR Project #20231690
County: Person
The Division has received an acceptance letter from the NC Division of Mitigation Services (DMS) to
satisfy the mitigation requirements set forth in 401 Individual Certification No. WQC006654 issued to
Brooks Lockhart & The City of Roxboro, dated February 15, 2024, as provided in the table below.
Compensatory Mitigation
River and 8-digit HUC Number
Riparian Wetland
0.123 acres (credits)
Neuse River Basin
03020201
(Outside Falls Watershed)
The Permittee must provide a copy of this form to DMS who will then sign the form to verify receipt of
payment and the transfer of the mitigation responsibility. Once DMS has signed this form, it is the
Permittee's responsibility to ensure that a signed copy of this form is submitted to the Division before
conducting any of the authorized impacts.
The Division of Mitigation Services verifies that the mitigation requirements (credits) shown above will
be debited using approved released or advance credits, and for all stream or wetland credits is in
accordance with the signed/approved In -Lieu Fee Instrument dated July 28, 2010. By signing below,
DMS is accepting full responsibility for the identified mitigation. As a reminder to the Mitigation
Provider, no more than 25 percent of the total mitigation required by Division can be met through
preservation, unless requested and approved by the Division Director (15A NCAC 02H. 0506(c)(7)).
Signature Authority Name (print): Kelly Williams for NCDMS
Signature: Date: 16 May 2024
p North Carolina Department of Environmental Quality I Division of Water Resources
D�J) Raleigh Regional Office I 3800 Barrett Drive I Raleigh, North Carolina 27609
NOR1H CARouNa �/ 919.791.4200